Child Sexual Abuse Thesis

Child sexual abuse is a major social and familial issue that has impacted the lives of many people throughout the world. Although the maltreatment of children in any form is deplorable, sexual abuse of children has a particularly cruel stigma. The purpose of this discussion is to examine the impact sexual abuse has on victims and the interventions for victims. The discussion will begin by defining child sexual abuse.

Defining Child Sexual Abuse

According to the Encyclopedia of Childhood and Adolescence, sexual abuse is defined as sexual contact with an adult or older child through coercion or deceptive manipulation at an age and stage of development at which they do not possess sufficient maturity to understand the nature of the acts and therefore to provide informed consent. In most cases physical force is not necessary since the perpetrator is likely to be someone with whom the child has a trusting relationship and who is in a position of authority over the child. Sexual abuse can range from requiring the child to view pornographic material (i.e., movies and magazines) to having the child commit sexual acts (Selby, 2008).

Prevalence of Child Sexual Abuse

The American Psychological Association reports that

"precise statistics on the prevalence of child and adolescent sexual abuse are difficult to collect because of problems of underreporting and the lack of one definition of what constitutes such abuse. However, there is general agreement among mental health and child protection professionals that child sexual abuse is not uncommon and is a serious problem in the United States."

With this understood large population-based surveys have found that between 15% and 25% of the general female population have been sexually abused (Molnar et al. 2001, Walker et al. 1999, Cloutier et al. 2002). In addition "Estimates of sexual abuse are even higher when surveying female patients with unexplained or functional pain (e.g., irritable bowel syndrome [IBS], pelvic pain of unknown origin), psychiatric illness, and substance abuse (Leserman 2005)." Statistics also show that population-based surveys have repeatedly shown higher rates of sexual abuse among women when compared to men . However, research indicates that Whites and Blacks tend to have the similar amounts sexual abuse prevalence have (Tjaden 1998). However research has shown that cases of sexual abuse tend to be higher amongst Native Americans (Tjaden 1998). Additionally "two population-based studies showed no differences in education between abused and nonabused, whereas 3 large probability surveys showed that sexually abused had more education, and 1 showed they had less education (Wise et al., 2001; Leserman, 2005)."

Indeed sexual abuse is a widespread problem that can have devastating results for the victim and society as a whole. The following paragraphs will discuss the impact of child sexual abuse.

The Impact of sexual Abuse

Sexually abused children can suffer from wide range mental, emotional and physical issues. These issues are often first apparent with the context of school performance. Children who have experienced abuse may experience problems in school associated with attention, focusing and behavioral problems. Dowling & Mullers (2008) explain that long-term effects include post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), and behavior problems including withdrawal, sexualized behavior and acting-out. Issues in relation to depression, anxiety, suicidal ideation, bipolar disorder, violence and substance abuse also follow child sexual abuse (CSA).

According to the American Psychological Association, re-victimization is a common behavior exhibited by children who have been sexually abused. Although sexual abuse is an experience and not a diagnosis, the experience of being sexually abused may lead to some diagnosable disorders. The difficulty associated with maturation is compounded when children have been subjected to abuse. It is extremely necessary for practitioners, researchers, educators and parents arm themselves with knowledge of signs and symptoms of sexual abuse. The effects of sexual abuse are long lasting and often require intense therapy and treatment for children to heal and over come the trauma associated with sexual abuse.

In addition to psychological issues associated with sexual abuse, there are also physical issues that can occur as a result of sexual abuse. According to Leserman (2005) over the past ten years many studies have found that people who were sexually abused as children have higher incidences of physical health problems (907). In some cases these physical problems occur long after the abuse has occurred (907).

Leserman (2005), also explains that studies involving clinics, HMOs and primary care facilities have found links between sexual abuse and higher levels of reported gastrointestinal problems and abdominal pain (McCauley et al. 1997;Walker et al. 1999;Hulme 2000). In fact in most of these studies people who were sexually abused reported gastrointestinal problems at twice the rate of people who had not been sexually abused. In fact as early as a decade ago McCauley et al. (1997)

"found that among women who were abused inchildhood, 46% reported abdominal pain, 36% had diarrhea, and 39% had constipation in the past 6 months compared with 28%, 24% and 26% of the nonabused, respectively. In a random sample of women HMO members, those with sexual maltreatment reported more nausea (8%) and abdominal pain (22%) compared with those with no maltreatment (4% and 14%, respectively); diarrhea and constipation did not differ between groups (Walker et al., 1997). In a random survey of Los Angeles women, the sexually assaulted had about twice the risk of reporting gastrointestinal symptoms (41%) such as vomiting, nausea, abdominal pain, diarrhea, and bloating compared with the nonassaulted (26%) (Golding 1994; Leserman 2005)

The author also explains that women who were sexually assaulted as children reporter greater incidences of painful sexual intercourse (dyspareunia), pelvic pain, painful menstruation (dysmenorrhea), vaginal infection, and other gynecologic problems (Leserman 2005). Studies have also found that women who were sexually abused were twice as likely to report pelvic pain and vaginal discharge when compared to women who had not been abused (Leserman 2005).

All of the aforementioned problems that can occur as a result of child sexual abuse are treatable. Given the proper interventions those that have been abused are able to cope with the stigma, psychological and physical problems that may arise. The following section of this discussion will focus on the interventions that are often utilized to assist people who have been sexually abused.

Interventions for victims

Indeed people who have been sexually abused suffer from various trauma, disorders and/or illnesses as a result of their abuse. There is no single intervention that serves as a cure all. As such individualized treatment is necessary in order to address the specific needs of each child. For this reason, there are numerous interventions that are commonly used to assist in the treatment of children who have been sexually abused. Treatment for these children can range from art therapy and play therapy, to group and individual therapy and cognitive behavioral therapy. The type of therapy used will depend largely on the type of behavioral, emotional, and mental disturbances that the child is experiencing. Another factor in the treatment selection is age and mental capacity of the child (Brown, 2005). A comparison and contrast of art therapy, play therapy, cognitive-behavioral therapy and pharmacologic therapy will be provided in the following paragraphs

Art Therapy

Art therapy has recently emerged as a viable type of intervention for victims of sexual abuse. It may be inclusive of any form of the arts including music, visual arts, acting and writing. Art therapy is believed to be beneficial for sexual abuse victims because it can assist in the reestablishment of self-esteem. According to Brooke (1994), the visual arts are particularly useful in the regard. The author explains

"To create something and ultimately confront that creation, even if it represents traumatic material, allows one to reabsorb the event in a restructured form.

Viewing these self-directed visual solutions demonstrates that internal chaos can be formed and redefined often without overwhelming the client. Self mastery, empowerment and assertiveness become possible as the ego recognizes victory over once elusive and frightening internal forces (Brooke 1995, 498)."

According to this assertion art therapy is useful in treating victims of child sexual abuse because it gives them the power to confront their fears through artistic expression. In other words art allows them the cathartic release necessary to confront the psychological issues that are present because of the abuse.

Art therapy can be used for the purposes of storytelling, short-term trauma resolution, in play therapy and forensic investigations (Liebmann, 2003). In addition art therapy is most often utilized with people who are dealing with Attention Deficit Hyperactivity Disorder, sexual abuse, Autism, medical art therapy, adolescent depression, eating disorders, bereavement, severe mental illness, addictions and many other situations (Liebmann, 2003). Art therapy is a unique way that children can express their thoughts and feeling and disclose some of trauma that was experienced as a result of their abuse.

As a result of having a limited vocabulary and an inability to articulate what has happened to them, it is often hard for children to discuss the details of their abuse. Art therapy gives an outlet,…
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